There are several treatments which are for variceal bleeding in patients with cirrhosis.
In this study, a team of physicians assessed how these treatments are used in clinical practice. They also evaluated the posttherapeutic prognosis and prognostic indicators of upper digestive bleeding in patients with cirrhosis.
The researchers included a training set of 291 and a test set of 174 bleeding cirrhotic patients in this study.
The treatments were allocated according to the preferences of each center. There was a follow-up period was 6 weeks.
|5-day failure rate was 13%.|
The team developed predictive rules for 5-day failure (uncontrolled bleeding, rebleeding, or death) and 6-week mortality using a logistic model in the training set. These rules were validated in the test set.
They established that initial treatment controlled bleeding in 90% of patients. Therapy included vasoactive drugs in 27% of patients, endoscopic therapy in 10%, combined endoscopic and vasoactive treatment in 45%, balloon tamponade alone in 1%, and none in 17%.
They determined that the 5-day failure rate was 13%, 6-week rebleeding was 17%, and mortality was 20%.
The physicians found that for 5-day failure, variceal bleeding occurred in 15%, compared to nonvariceal bleeding in 7%. For 6-week rebleeding 19% was variceal and 10% nonvariceal, and when mortality occurred 20% of bleeding was variceal and 15% nonvariceal.
They determined that active bleeding on endoscopy, hematocrit levels, aminotransferase levels, Child-Pugh class, and portal vein thrombosis were significant predictors of 5-day failure. However, alcohol-induced etiology, bilirubin, albumin, encephalopathy, and hepatocarcinoma were predictors of 6-week mortality.
Prognostic reassessment including blood transfusions improved the predictive accuracy.
The team found that all the developed prognostic models were superior to the Child-Pugh score.
Drs Gennaro D'Amico and Roberto De Franchis concluded that the, "Prognosis of digestive bleeding in cirrhosis has much improved over the past 2 decades".
"Initial treatment stops bleeding in 90% of patients".
"Accurate predictive rules are provided for early recognition of high-risk patients".